Invasive group A, C and G streptococcal disease in western Norway: virulence gene profiles, clinical features and outcomes

Abstract

Invasive group A streptococcal (iGAS) disease is endemic in Norway, but data on invasive group C and group G streptococcal (iGCS/GGS) disease are lacking. We investigated the characteristics of iGAS and iGCS/GGS infections in western Norway from March 2006 to February 2009. Clinical information was retrospectively obtained from medical records. GAS and GCS/GGS isolates were emm typed and screened for the presence of 11 superantigen (SAg) genes and the gene encoding streptococcal phospholipase A₂ (SlaA). GCS/GGS isolates were also subjected to PCR with primers targeting speG(dys) . Sixty iGAS and 50 iGCS/GGS cases were identified, corresponding to mean annual incidence rates of 5.0 per 100,000 and 4.1 per 100,000 inhabitants, respectively. Skin and soft tissue infections were the most frequent clinical manifestations of both iGAS and iGCS/GGS disease, and 14 iGAS patients (23%) developed necrotizing fasciitis. The 30-day case fatality rates of iGAS and iGCS/GGS disease were 10% and 2%, respectively. emm1, emm3 and emm28 accounted for 53% of the GAS isolates, and these types were associated with severe clinical outcome. SAg gene and SlaA profiles were conserved within most of the GAS emm types, although five profiles were obtained within isolates of emm28. stG643 was the most prevalent GCS/GGS emm type, and speG(dys) was identified in 73% of the GCS/GGS isolates. Neither GAS SAg genes nor SlaA were detected in GCS/GGS. Our findings indicate a considerable burden of both iGAS and iGCS/GGS disease and a high frequency of necrotizing fasciitis caused by GAS in our community.

Adult Invasive and Noninvasive Infections Due to Streptococcus dysgalactiae subsp. equisimilis in France from 2006 to 2010

“…equisimilis human diseases is uncertain. spegg was not associated with invasive infections but was associated with certain emm types, as previously reported (26,32). It should be noted that the rates of erythromycin and tetracycline resistance of S. dysgalactiae subsp.…”

New Tricks from an Old Cow: Infective Endocarditis Caused by Streptococcus dysgalactiae subsp. dysgalactiae

“…IE is caused by either Staphylococcus aureus or viridans group streptococci in around 50% of the cases (15), whereas IE caused by GCS belonging to S. dysgalactiae subsp. equisimilis is indeed a rarity (1,16,17). To our knowledge, S. dysgalactiae subsp.…”

Staphylococcal and Streptococcal Superantigen Exotoxins

“…Other beta-hemolytic streptococci, including group B, C, and G strains, also have the ability to cause serious human illnesses, including streptococcal TSS with or without necrotizing fasciitis and myositis (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Additionally, group B streptococci are well known to cause neonatal sepsis and meningitis, and group C and G strains cause pharyngitis.…”